Fractures

The realignment of displaced, angulated, or rotated fracture fragments is referred to as reduction. In some cases, it is unnecessary or impractical to reduce a fracture, e.g. relatively nondisplaced fractures of the fibular diaphysis. In other cases, nearly exact anatomic reduction is required, e.g. fractures of articular surfaces to prevent subsequent degenerative joint changes. Open reduction refers to operative manipulation at the fracture site. Closed reduction refers to external manipulation to achieve reduction. Similarly, internal fixation is achieved by surgically placing hardware at the fracture site. External fixation can be achieved with casts or splints. External fixation can also be performed with pins placed through bone remote from the fracture site which can then be used in traction or fixation devices.

Fractures heal more quickly when there is apposition and compression of fracture fragments. While closed reduction and closed fixation should be employed whenever possible, open reduction and internal fixation with orthopedic hardware is often necessary to reduce complex fracture and provide optimal compression of fracture fragments.

The main types of hardware used for compression are compression plates, lag screws, and tension band wires. These methods are discussed more thoroughly in the atlas section. Compression can be either static or dynamic. Orthopedic hardware used for static compression provides fixed, uniform compression at a fracture site. Compression plates and lag screws are used for static compression. In dynamic compression, the patient's body weight and muscle contractions supply compressive forces while the hardware supplies fixation. The dynamic hip screw, a type of lag screw, uses weight bearing for compression while tension band wiring uses rotational forces at joints for compression.